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General NPI Number Information
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NPI Number | 1871619007
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Entity Type | Individual
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Provider Name | MARISA ANN MIKALS D.C.
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 4900 IVEY RD NW SUITE 820
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City | ACWORTH
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State | GA
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Zip | 30101-4001
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Country | US
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Telephone | 770-975-9233
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Fax |
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Provider Business Mailing Address
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Address Line | 2406 OWENS LANDING WAY NW
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City | KENNESAW
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State | GA
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Zip | 30152-6551
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Country | US
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Telephone | 770-309-1816
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 007163
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License Number State | GA
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